摘 要目的:近10年来关于原发性醛固酮增多症的诊断指南层出不穷,却没有关注这些指南的质量。本研究目的是评价各指南的质量,对原发性醛固酮增多症的筛查和确诊实验提出建议。方法:系统性检索了近10年的PUBMED和电子指南数据库的文献,9篇指南符合要求并运用AGREE工具及其他标准进行评价。比较了指南推荐的建议及其引用参考文献的差异并探寻其原因。结果:在3192篇参考文献中,9篇指南被评价,其中2篇指南被强烈推荐,2篇指南被推荐,其他的则不被推荐。对于原发性醛固酮增多症诊断的建议,多数指南意见一致,但其引用证据几无重叠。结论:不同的指南对于原发性醛固酮增多症诊断建议存在分歧,原因在于非系统性的指南研发,证据不充分,证据解释不同,专业的影响等。因此,我们建议指南研发者应严格按照AGREE标准来制定指南,尽力提供每个建议的证据来源,创建一个由多个国家不同领域专家组成的团队。

    关键词AGREE;原发性醛固酮增多症;诊断;指南;循证医学

    AbstractPurpose: There has been a rapid expansion in the number of clinical practice guidelines for primary aldosteronism (PA) over the past decade, but little is known about which guidelines(GLs) to follow. Therefore, this study is done to assess the quality of the GLs, and to give advice on the recommendation on diagnosis of PA for future. Methods: After systematic searches of pubmed and electronic guideline databases between 1999 and 2008, 9 PA GLs were selected and scored for methodological quality using the AGREE Instrument. Then we extracted and compared recommendations among a range of guideline and analyzed to what extent the variation or concordance among recommendations was explained by the evidence cited in the guideline.Results: Of the 3192 referrences, 9 GLs were evaluated by the AGREE instrument. 2 GLs, were strongly recommended, and 2 GLs ,recommended with alteration, but 5 GLs would not be recommend. The recommendations made in the guidelines were in agreement about general diagnosis of PA, with some important differences in details. There was little overlap in evidence cited by the guidelines. Conclusions: It is evident that there are disparities in diagnostic recommendation in guidelines for PA, reflecting unsystematic guideline development, insufficient evidence, differing interpretation of evidence, the influence of professional bodies. Therefore, efforts will be further needed to close the evidence gaps in the field of the diagnosis of PA and to create a joint task force to reach a common document by using the AGREE criteria. ......